1. Interventional Radiologists- Where will they go next?
Dr Simon Travis
MB ChB FRCR
Vascular/Interventional Radiologist
Nottingham University Hospitals

2. What is an Interventional Radiologist?

3. Global Statement Defining Interventional Radiology
J Vasc Interv Radiol 2010; 21:1147–1149
1. Expertise in diagnostic imaging and radiation safety.
2. Expertise in image-guided minimally invasive procedures and techniques as applied to multiple diseases and organs.
3. Expertise in the evaluation and management of patients suitable for the image-guided interventions included in the scope of IR practice.
4. Continual invention and innovation of new techniques, devices, and procedures.

4. History
1964 Angioplasty
1966 Embolization therapy to treat tumors and spinal cord vascular malformations by blocking the blood flow
1967 The Judkins technique of coronary angiography, the technique still most widely used around the world today
1967 Closure of the patent ductus arteriosis, a heart defect in newborns of a vascular opening between the pulmonary artery and the aorta
1967 Selective vasoconstriction infusions for hemorrhage, now commonly used for bleeding ulcers, GI bleeding and arterial bleeding
1969 The catheter-delivered stenting technique and prototype stent
Tools for interventions such as heparinized guidewires, contrast injector, disposable catheter needles and see-through film changer
1970’s Percutaneous removal of common bile duct stones
1970’s Occlusive coils
1972 Selective arterial embolization for GI bleeding, which was adapted to treat massive bleeding in other arteries in the body and to block blood supply to tumors

5. 1973 Embolization for pelvic trauma
1974 Selective arterial thrombolysis for arterial occlusions, now used to treat blood clots, stroke, DVT, etc.
1974 Transhepatic embolization for variceal bleeding
Embolization technique for pulmonary arteriovenous malformations and varicoceles
Bland- and chemo-embolization for treatment of hepatocellular cancer and disseminated liver metastases
1980 Cryoablation to freeze liver tumors
1980 Development of special tools and devices for biliary manipulation
1980’s Biliary stents to allow bile to flow from the liver saving patients from biliary bypass surgery
1981 Embolization technique for spleen trauma
1982 TIPS (transjugular intrahepatic portosystemic shunt) to improve blood flow in damaged livers from conditions such as cirrhosis and hepatitis C
1982 Dilators for interventional urology, percutaneous removal of kidney stones
1983 The balloon-expandable stent (peripheral) used today

6. 1985 Self-expanding stents
1990 Percutaneous extraction of gallbladder stones
1990 Radiofrequency ablation (RFA) technique for liver tumors
1990’s Treatment of bone and kidney tumors by embolization
1990’s RFA for soft tissue tumors, i.e., bone, breast, kidney, lung and liver cancer
1991 Abdominal aortic stent grafts
1994 The balloon-expandable coronary stent used today
1997 Intra-arterial delivery of tumor-killing viruses and gene therapy vectors to the liver
1999 Percutaneous delivery of pancreatic islet cells to the liver for transplantation to treat diabetes
1999 Developed the endovenous laser ablation procedure to treat varicose veins and venous disease

7. Why Interventional Radiology
Shorter Hospital Stays
Money Saving
Reduction in Transfusion Requirements
Better QoL for patients
Faster Recovery
High Intensity Localised treatments

9. What’s Our Role in Chronic Care? Vascular
Treatment of Ischaemic limbs
Diabetic foot ulcers
Management of Aneurysms of the Aorta and Visceral vessels
Vascular Access Management for Renal Replacement Therapy
Varicose Vein Ablation
Renal Artery Disease
AVM management

11. Oncology Vascular Access (ports and lines) Image Guided Biopsy
Tumour Ablation RF
Cryo
Microwave
Focused U/S
Tumour Embolisation with Chemotherapy
SVC Stenting for SVCO
Portal Vein Embolisation Prior to Hepatic Resection

13. Gastrointestinal Percutaneous Bile Duct Management
Colonic Stenting as a Bridge to Surgery (CREST trial)
Oesophageal Stenting
Gastrostomy Insertion
TIPSS for Ascites Control in Hepatic Cirrhosis

15. Other Conditions Uterine Fibroid Embolisation for Symptom Relief
Vertebroplasty for Pain Relief
Tunnelled Pleural and Ascitic Drains

17. What’s Our Role in Acute Medical Care?
Control of Haemorrhage
Uterine Postpartum (Health Commission report on Northwick Park)
Acute Aneurysm Rupture
Acute Aortic Dissection
Post Traumatic Vascular and Visceral Injury
GI Haemorrhage
Acutely Ischaemic Limbs
DVT and PE management
Emergency Venous Access in Dialysis Patients

19. What’s New?
Renal Artery Denervation for Difficult to Control Hypertension
Prostate Embolisation
Desolving Stents

20. Renal Artery Denervation
Transarterial Catheter directed RF Ablation of Renal Sympathetic Nerves
Good results from proof of principal cohort study (45 patients with drug resistant hypertension)

21. Prostate Embolisation for BPH
Injection of micro particles ( micron) into the prostatic arteries to shrink the organ
Promising results in animal and human studies
Day case procedure with the potential for a return towards normal micturition with out medication (better QoL and cost saving)

22. How Will We Affect Health Care in The Future
Save Money
Reduced Bed stays
Reduced Transfusion Requirements
More Rapid Patient Recovery
More Rapid Return to Normal Life/Work
Improve QoL for Patients
More Procedures by the month
Better Cancer Outcomes

23. Interventional Radiology
Has been recognised as a distinct subspeciality by the Royal Colleges
We now have our own training program
We have our own syllabus
3 years of Radiology Training followed by 3 years of Interventional Training

24. Finally

25. Train Patients to do Their Own Procedures?